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Treatment > Medications

Mesalazine for the treatment of ulcerative colitis

Dr. med. André Sommer

Dr. med. André Sommer

The active substance mesalazine is often used in the treatment of acute flare-ups of ulcerative colitis and for long-term disease control. It inhibits the formation of messenger substances in the body and thus reduces inflammation.

What is mesalazine?

Mesalazine is also called 5-amino-acrylic acid (5-ASA) and is available from numerous manufacturers in the following dosage forms:

  • Tablets
  • Granules
  • Rectal foam
  • Suppositories
  • Enema

What is mesalzine and how does it work?

The exact mechanism of action of mesalazine is unknown. However, it is known that it inhibits the production of important inflammatory substances by using the enzyme cyclooxygenase.

The active ingredient also has an immunosuppressive activity. By inhibiting important inflammatory substances (cytokines), the proliferation of immune cells that are involved in the inflammation of ulcerative colitis and Crohn's disease is reduced.

At a glance: Active ingredient that is primarily used in the treatment of ulcerative colitis Prevents the production of important inflammatory substances and thus reduces inflammation of the intestine The exact mechanism of action is unknown

How fast does mesalazine work?

How much time it takes for a noticeable improvement depends on various factors. The progress of the disease influences the rate of action. And the affected section of the intestine also has an effect. Usually, patients make an improvement between two and eight weeks after the start of therapy. These improvements can be seen through, for example decrease in stool frequency or that disappearance of blood in the stool.

Nutrition also plays a significant role in inflammatory bowel disease. Our Cara Care nutritionists support those affected to additionally improve their digestive health through an individual diet. Find out more about how we do it here.

What are the side effects of mesalazine?

Especially compared to sulfasalazine, which also belongs to the drugs of the 5-ASA group, mesalazine has fewer side effects:

  • Fever, difficulty breathing
  • Headache, dizziness
  • Inflammation of the heart muscle or sac
  • Abdominal pain, diarrhea, flatulence, nausea, vomiting
  • Photosensitivity
  • Allergic rash
  • Changes in blood count (very rare)

Sensitivity to light can lead to severe reactions, particularly in patients with previous skin diseases such as neurodermatitis.

However, hair loss as a side effect occurs in less than three percent of patients. However, it is controversial whether the hair loss is due to the medication or chronic bowel disease as the underlying disease. A recent study shows that patients with inflammatory bowel disease who have been treated with mesalazine have a lower risk of developing hair loss.

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Where can I get mesalazine?

Mesalazine requires a prescription and is available in the pharmacy with a co-payment of up to 10 euros in Germany. The different dosage forms are available in the following dosages from 250mg to 4000mg, whereby the prices vary slightly depending on the manufacturer.

Quantity Pharmacies selling price Patient costs
Tablets 1g 50 pieces €53.29 5.33
Granules 1g 50 pieces 53.19-61.53€ 5.32€-6.15
Rectal foam 1g 80g 62.82€-63.07 6.28€-6.31
Suppositories 1g 10 pieces 42.44€-42.98 €5.00
Enema 4g 21 pieces €156.66 €10.00

Who shouldn't use mesalazine?

The following overview lists patient groups that should not use mesalazine:

  • Those with hypersensitivity to mesalazine or salicylates (contained in aspirin)
  • Severe liver dysfunction
  • Severe kidney dysfunction
  • Stomach ulcers or increased bleeding tendency
  • Pregnant and breastfeeding women

I am pregnant or breastfeeding - can I use mesalazine?

The use of mesalazine in pregnancy has not been adequately investigated. Therefore, for safety's sake, the drug should only be used in exceptional cases during pregnancy. As a result, the attending physician should always have a say in whether the benefits of the treatment outweigh the possible risks.

The active ingredients of mesalazine can be detected in breast milk in small amounts. Therefore, the treating doctor must also be consulted. If the infant develops diarrhea, breastfeeding must be stopped immediately.

When is mesalazine used?

Mesalazine is the first step in the treatment of acute episodes of ulcerative colitis and in maintenance therapy. Mesalazine is used as a suppository and enema, particularly for rectal ulcerative colitis and left colon disease. If other parts of the intestine are affected, the use of granules or tablets is recommended.

Mesalazine plays a subordinate role in Crohn's disease. While older studies show a good effectiveness, the current data situation is very controversial. Therefore, use in Crohn's disease is only recommended if there is slight inflammatory activity, if this is expressly requested by the patient, or if there is a contraindication to therapy with glucocorticoids.

It can also be used to treat uncomplicated diverticulitis. However, there is no uniform data on the use, which is why the therapy is generally not recommended.

How do I take mesalazine?

  • Granules: Put the granules on your tongue and swallow them with plenty of liquid. The granules must not be chewed
  • Tablets: It is best to take the tablets whole, with plenty of liquid, one hour before meals
  • Rectal foam: You should empty the bowel before use. The foam should be at room temperature and must be shaken for about 20 seconds. Then insert the applicator into your rectum as deeply as possible and comfortably for you. Apply the rectal foam and hold the applicator in the same place for 10-15 seconds. You can then remove the applicator
  • Suppositories: You should empty your bowels before use. Then place the suppository rectally
  • Enema: You should empty your bowels before use. Shake the vial. Then lie on your left side and stretch out your left leg while bending your right leg. Insert the applicator tip into your rectum and empty it. After pulling the applicator out of your anus, you should remain in the same position for at least 30 minutes so that the medication can be optimally distributed

What can I do if mesalazine stops working?

It is important to differentiate when the medication stops working.

If mesalazine loses its effectiveness in an acute episode, other drugs such as glucocorticoids (cortisone) should be included in the therapy. If mesalazine is insufficient in the maintenance therapy of ulcerative colitis, treatment with azathioprine, glucocorticoids and infliximab can be intensified.

Gomollón, F., Dignass, A., Annese, V., Tilg, H., Van Assche, G., Lindsay, J. O., ... & Rieder, F. (2016). 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 1: diagnosis and medical management. Journal of Crohn's and Colitis, 11(1), 3-25.

Preiß, J. C., Bokemeyer, B., Buhr, H. J., Dignaß, A., Häuser, W., Hartmann, F., ... & Kucharzik, T. (2014). Aktualisierte S3-Leitlinie–„Diagnostik und Therapie des Morbus Crohn “2014. Zeitschrift für Gastroenterologie, 52(12), 1431-1484. Downloaded on 06.06.2019 from:

Kucharzik, T., Dignass, A. U., Atreya, R., Bokemeyer, B., Esters, P., Herrlinger, K., ... & Schreiber, S. (2018). Aktualisierte S3-Leitlinie Colitis ulcerosa der Deutschen Gesellschaft für Gastroenterologie, Verdauungs-und Stoffwechselkrankheiten (DGVS). Zeitschrift für Gastroenterologie, 56(09), 1087-1169. Downloaded on 06.06.2019 from:

Pruitt, R., Hanson, J., Safdi, M., Wruble, L., Hardi, R., Johanson, J., ... & Doty, P. (2002). Balsalazide is superior to mesalamine in the time to improvement of signs and symptoms of acute mild-to-moderate ulcerative colitis. The American journal of gastroenterology, 97(12), 3078.

Ford, A. C., Achkar, J. P., Khan, K. J., Kane, S. V., Talley, N. J., Marshall, J. K., & Moayyedi, P. (2011). Efficacy of 5-aminosalicylates in ulcerative colitis: systematic review and meta-analysis. The American journal of gastroenterology, 106(4), 601.

Shah, R., Abraham, B., Hou, J., & Sellin, J. (2015). Frequency and associated factors of hair loss among patients with inflammatory bowel disease. World Journal of Gastroenterology: WJG, 21(1), 229.

Leifeld, L., Germer, C. T., Böhm, S., Dumoulin, F. L., Häuser, W., Kreis, M., ... & Ritz, J. P. (2014). S2k-Leitlinie Divertikelkrankheit/Divertikulitis. Zeitschrift für Gastroenterologie, 52(07), 663-710. Downloaded on 02.07.2019 from:

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Dr. med. André Sommer

Dr. med. André Sommer

I’m André, a medical doctor from Berlin. Together with a team of medical doctors, nutritionists and data scientists we empower people to understand digestive issues with our app Cara Care.

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